TY - JOUR
AR - JICOA-2019-4-109
TI - Remote Ischemic Preconditioning on New Onset Post-Cardiac Surgery Atrial
Fibrillation: A Single-Centre Prospective Clinical Study
AU - Aidonidis, Isaac
AU - Befani, Christina
AU - Dipla, Konstantina
AU - Hatziefthimiou, Apostolia
AU - Liakos, Panagiotis
AU - Papadopoulos, Eleftherios
AU - Simopoulos, Vassilios
AU - Stamoulis, Konstantinos
AU - Tsilimingas, Nikolaos
JO - Journal of Integrative Cardiology Open Access
PY - 2019
DA - Sat 14, Dec 2019
SN - 2674-2489
DO - http://dx.doi.org/10.31487/j.JICOA.2019.04.09
UR - https://www.sciencerepository.org/remote-ischemic-preconditioning-on-new-onset-post-cardiac-surgery_JICOA-2019-4-109 
KW - Cardiac surgery, postoperative atrial fibrillation, remote ischemic preconditioning, cardiac troponin T, oxidative stress
AB - Background: Remote ischemic preconditioning (RIPC) has been shown to reduce myocardial ischemiareperfusion injury. However, its efficacy in preventing postoperative atrial fibrillation (POAF) remains
unsettled.
Methods: A total of 97 eligible patients were prospectively randomized to receive either RIPC or shamRIPC (control) prior to coronary artery bypass graft (CABG) surgery. RIPC was performed by applying 3
alternating cycles of a 5-min upper limb ischemia and reperfusion using a blood-pressure cuff. The primary
endpoint was the incidence of POAF. Secondary endpoints included cardiac troponin T (cTnT) and H2O2
serum concentration after revascularization, and P-wave duration (PWD) on a 12-lead electrocardiogram.
Results: Twelve out of 49 RIPC patients (24.5%) and 18/48 of control patients (37.5%) developed POAF
(p=0.165, χ2-test). H2O2 levels were significantly increased 30 min after revascularization in both groups
compared to pre-clamping values (8.8±6 vs 25.5±2 and 8.5±5 vs 39±15.5 µM/L in the RIPC and control
group, respectively; P<.001, within-group analysis). However, mean differences of H2O2 levels after
reperfusion were lower in RIPC patients than in controls (P<.05). cTnT concentrations though increased
between 6 and 12 h after operation in both groups, they began to fall later only in the RIPC group. PWD
became shorter in RIPC treated patients but not in controls when measured postoperatively (82±13 vs 75±11
ms, P<.01).
Conclusion: RIPC did not significantly reduce the incidence of POAF despite decreases in cTnT/H2O2
levels and PWD, indicating that not the extent of myocardial injury but the injury itself triggers the
electrophysiologic mechanisms underlying the development of this arrhythmia.